Am J Case Rep. 2025 Nov 25;26:e950495. doi: 10.12659/AJCR.950495.
ABSTRACT
BACKGROUND Branch retinal vein occlusion (BRVO) is a common cause of vision loss in older adults, and cystoid macular edema (CME) is its most frequent vision-threatening complication. Depending on severity, vitreomacular traction (VMT) is typically managed with observation or surgery. When CME develops during observation (e.g., in BRVO), the therapeutic approach becomes more complex. Anti-vascular endothelial growth factor (VEGF) therapy is a standard treatment for CME secondary to BRVO. Although full-thickness macular hole (FTMH) formation is rare, it has been reported in eyes with preexisting VMT, suggesting a contributory role for tractional forces. CASE REPORT A 72-year-old woman under observation for VMT developed BRVO with CME. Baseline optical coherence tomography revealed VMT, an epiretinal membrane, a lamellar macular hole, and a vertical hyperreflective line at the fovea resembling the "foveal crack sign". The patient received an intravitreal faricimab injection to achieve rapid edema resolution with fewer injections. CME improved; however, an FTMH subsequently developed, accompanied by a decline in best-corrected visual acuity to 20/33. The patient then underwent combined vitrectomy and cataract surgery, which achieved successful hole closure. CME recurred postoperatively but responded well to a second faricimab injection, resulting in visual recovery to 20/22. CONCLUSIONS FTMH may develop after anti-VEGF therapy in eyes with preexisting VMT. This appears to be the first reported case following faricimab treatment for BRVO-associated CME, underscoring the need for careful pretreatment evaluation of the vitreoretinal interface and awareness of potential tractional complications. Individualized treatment strategies may help reduce such risks and improve outcomes.
PMID:41289231 | DOI:10.12659/AJCR.950495